Dear Dr C,
I have been with one sexual partner (male) for several years, and I regularly test for STIs/STDs, including annual STI panels and HIV checks (which all comes back negative btw) However, I experience pain in my lower abdomen during intercourse. I am concerned about whether this pain might indicate an underlying condition or if it’s related to my partner. Could you help me understand if there are potential complications if I continue having sex with him?RESPONSE
Sx should be lots of fun and pain free unless you’re into pain. Since you describe your pain as being in your lower abdomen during sxual interc*urse, it appears that you are having pelvic pain upon deep thrusting.
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But, you still need to answer the following questions:
- Is there pain upon initial p*nile insertion?
- Is there pain inside your vgina during sx?
- Are there any positions that are more/less painful?
- Is there pain with clitor@l stimulation?
- Is there pain after s*x?
- Has intercourse always been painful?
- If you use tampons, is it painful to insert?
- Did the pain start acutely or gradually?
- Is the pain only during intercourse or is there pain without provocation?
- Since the pain began, have there been episodes of completely pain-free sex?
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The answers to the aforementioned questions will help your OB/GYN formulate differential diagnoses to be eliminated until a diagnosis is made. With deep dyspareunia (pain during s*x), possible causes include, but are not limited to: - Scaring from endometriosis.
- Interstitial cystitis.
- He’s hitting your ovaries or an ovarian cyst.
- Musculoskeletal pain.
- His pnis is too long and he’s trying to fit it all inside your vgina like a novice.
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Use positions with shallow penetration. When he puts you in backas, don’t put your head in the pillow. Stay on your hands or elbows. The more you bend forward, the deeper the penetration. Avoid putting your legs over his shoulders and being bent in half such that your ankles are positioned at your ears. That position leads to the deepest possible sxual penetration. ▪️ No matter the position, if you feel he’s too deep, place one hand around your partner’s pnis. It will decrease the depth of penetration whilst enhancing his pleasure. If you desire him deeper, release a finger or two. When you are ready for him to finish squeeze his pnis with your hand and vgina. That org@sm will sneak up on him like a ninja.
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You mentioned that your STI panel has been repeatedly negative (normal). Ask you OB/GYN to order a pelvic ultrasound to look for any ovarian cysts and/or uterine fibroids. Submit a urine sample to be tested for a urinary tract infection. If your cervical and vaginal discharge weren’t tested for mycoplasma and Ureaplasma, it should be done.
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If the pain persists, as a last resort, diagnostic laparoscopy (looking in your abdomen/pelvis for endometriosis) and diagnostic cystoscopy (looking into your urinary bladder for interstitial cystitis) may be necessary. If you have questions and/or concerns, you may reach me at @drcobgyn.
Best wishes,
Dr. C